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NPI Code Detail

MEDICARE: RONG FAN M.D.

MEDICARE: RONG FAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician01065131AIN
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician4301510501MI
3207ZP0213XPediatric Pathology Physician313196-01NY
4207ZP0102XAnatomic Pathology & Clinical Pathology Physician27457NV

General Provider Information

NPI Number : 1669648408
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONG FAN M.D.
Provider Business Mailing Address
First Line : 1355 RIVER BEND DR
Second Line :
City : DALLAS
State : TX
Zip : 75247-4915
Country : US
Telephone Number : 27-732-3441
Fax Number :
Provider Business Practice Location Address
First Line : 7455 W WASHINGTON AVE STE 301
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-4340
Country : US
Telephone Number : 702-732-3441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2008
Last Update Date : 07/18/2025

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